Vitamin B12 Deficiency In Children Research Articles

Vitamin B12 Deficiency in Children and Adolescents: A Case for Revised Diagnostic Parameters.

Vitamin B12 deficiency is commonly diagnosed using thresholds developed for adults, yet emerging evidence indicates these levels may not be appropriate for children and adolescents. This misalignment can lead to underdiagnosis in younger populations, with potential long-term health implications. Chief Complaint: The 17-year-old female patient experienced severe fatigue, menstrual irregularities, psychological distress, and neurological symptoms over several years. The 13-year-old male patient had behavioral changes, gastrointestinal complaints, and sensory disturbances from an early age.Diagnosis: Both adolescents displayed B12 levels that were considered low-normal based on adult thresholds, complicating their diagnostic processes. Their diverse and atypical symptomatology required a comprehensive review of their medical and family histories, clinical symptoms, and risk factors.Intervention: Treatment included administration of hydroxocobalamin injections, complemented by dietary adjustments.Outcome: Both patients responded well to the treatment, showing significant improvements in their symptoms and overall quality of life. The main takeaway from these cases is the importance of tailoring diagnostic adequate thresholds and treatment plans to the pediatric population to address and manage B12 deficiency effectively. This approach can significantly enhance patient outcomes and prevent the progression of potentially severe complications in later life.

Prevalence and Predictors of Vitamin B12 Deficiency in Children with Severe Acute Malnutrition, and its Association with Development.

To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development. In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II). The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated (P <0.001) with developmental delay. There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.

DIAGNOSIS OF VITAMIN B12 DEFICIENCY IN CHILDREN BY USING METHYLMALONIC ACID, HOMOCYSTEINE AND HOLOTRANSCOBALAMINE

Objective: Vitamin B12 deficiency is a common health issue in children. Though the sensivity of serum vitamin B12 measurement for the diagnosis of vitamin B12 deficiency is low, combined methylmalonic acid, homocysteine and holotranscobalamin have been reported to be more specific biomarkers in early and accurate diagnosis. In this study, we aimed to verify the diagnosis of vitamin B12 deficiency in children by measuring methylmalonic acid, homocysteine, holotranscobalamin and to determine the accuracy of them.&#x0D; &#x0D; Material and Methods: The study included 277 patients aged

Frequency of Vitamin B12 Deficiency in patients of Pancytopenia

Background: Vitamin B12 insufficiency is prevalent in developing nations. It often causes megaloblasticanemia, but it may also impact the other two cell lines, i.e. platelets and leukocytes (pancytopenia), and may be misdiagnosed as cancer or bone marrow failure. A therapeutic test may be performed, providing a prompt diagnosis and preventing a high death rate. Aim To find frequency of vitamin B12 deficiency in children having pancytopenia. Methodology: This cross sectional study was done at Children's Hospital &amp;The Institute of Child Health Lahore in 6 months. This study involved 242 children of 6 months to 14 years age of both genders admitted in Children Hospital Lahore and had pancytopenia on their CBC. Results: The age of the patients ranged from 6 months to 14 years with a mean of 6.4±2.8 years. There were 111(45.9%) male and 131 (54.9%) female patients with a male to female ratio of 1:1.2. A total of 6.2% patients were found to have B12 deficiency. Conclusion: It is concluded that, 6.2% of patients with pancytopenia had a deficiency of B12; thus, patients may be routinely evaluated for pancytopenia and its reasons, since many of them are entirely curable and others are managed. Keywords: Vitamin B12 deficiency, cobalamin, Pancytopenia, Megaloblastic

Hydroxocobalamin Treatment and Pediatric Migraine Disability Assessment Scale Scores

AbstractMigraine is a common neurologic disorder in children, especially in adolescents. It can affect the school performance, family, and social daily activities. The Pediatric Migraine Disability Assessment Scale (PedMIDAS) is commonly used in young patients. This study evaluated vitamin B12 deficiency in children with migraine and the effect of hydroxocobalamin treatment on PedMIDAS scores. The study group comprised patients with vitamin B12 deficiency and diagnosed migraine. The PedMIDAS questionnaire was conducted before and 3 months after hydroxocobalamin treatment. PedMIDAS scores were evaluated and compared before and after hydroxocobalamin treatment. The mean ± standard deviation of vitamin B12 level was 175.9 ± 21.3 pg/mL in children with migraine. The PedMIDAS scores were significantly lower after hydroxocobalamin treatment than before treatment (p &lt; 0.001). These results indicated that hydroxocobalamin made a positive contribution to the mitigation of migraine symptoms in children and that treating vitamin B12 deficiency could be a useful option.

INFANTILE TREMOR SYNDROME IN CHILDREN AND MATERNAL VITAMIN B12 DEFICIENCY: A TIME FOR PRIMARY PROPHYLAXIS

Objective: The aim of the study was to determine the percentage of Vitamin B12 deficiency in mothers of children suffering from infantile tremor syndrome (ITS). Other objectives were to determine the percentage of Vitamin B12 deficiency in children and to look for percentage of children having neurological changes in contrast enhanced computed tomography (CT) scan of brain. Methods: Data of children between 1 and 60 months admitted between April 2019 and December 2019 with ITS in a tertiary care hospital were collected. Serum Vitamin B12 levels of both mother and child were determined. Vitamin B12 deficiency and insufficiency were defined as levels &lt;200 pg/ mL and 200–350 pg/mL, respectively. The primary outcome was percentage of mother with Vitamin B12 deficiency and the secondary outcomes were percentage of children with Vitamin B12 deficiency and percentage of children with cerebral atrophy on contrast-enhanced CT of brain. Results: Forty-five children were enrolled in our study. Vitamin B12 deficiency was found in 29 (64.4%) children and 22 (55%) of their mothers. Cerebral atrophy in CT scan was found in 29 (70%) out of 41 children. Conclusion: The most of the mothers of children with ITS are also Vitamin B12 deficient. ITS occurs in infants and toddler with underlying Vitamin B12 deficiency and causes early cerebral atrophy in children, which is crucial period of brain growth. Hence, screening and supplementing anemic pregnant women with vitamin B12 can be one of the primary prevention in India.

Sublingual spray treatment of vitamin B12 deficiency in children

Objective: Vitamin B12 deficiency can lead to serious health problems both in children and adult. Intramuscular injection therapy is applied as the gold standard in the treatment of vitamin B12 deficiency. There are also oral, nasal, and sublingual spray treatment methods. In this study, we aimed to show the efficacy of sublingual spray treatment of vitamin B12 deficiency in children. Materials and Methods: Forty-five pediatric patients (25 boys, 20 girls), aged 9-36 months with serum cobalamin concentrations less than 200 pg/mL, were treated with sublingual vitamin B12 (methylcobalamin) spray. All patients were treated for four months by giving 500 μg oral spray daily for the first week, every other day for the next one week, two days a week for the next two weeks and then once a week for four months. Vitamin B12 levels were checked after four months. Results: Post-treatment vitamin B12 values were significantly higher than pre-treatment values (p<0.001). Vitamin B12 levels increased from 161.58±32.98 pg/mL to 427.44±148.58 pg/mL. After the treatment, the vitamin B12 level of all patients was found to be >200 pg/mL, except for only two patients. Vitamin B12 levels returned to normal in 96% of the patients with a sublingual spray treatment. Conclusions: Data from this study indicate that sublingual vitamin B12(methylcobalamin) spray (500μg) for four months is effective for treatment of children with vitamin B12 deficiency. Sublingual spray that is easier and more practical to use can be preferred for children with vitamin B12 deficiency instead of parenteral and oral vitamin B12 therapy.

Chronic Diarrhoea: A Rare Presentation Of Vitamin B12 Deficiency Anemia In Children

Vitamin B12 deficiency in children often under reported and usually presents with nonspecific manifestations like neuropsychiatric symptoms, anaemia, glossitis and chronic diarrhoea. Vegetarianism, minimal intake of animal products, poverty and malnutrition may lead to vitamin B12 deficiency. Laboratory reports often show pancytopenia, megaloblasts in bone marrow and low serum cynocobalamine. Injectable vitamin B12 is the treatment of choice. We would like to highlight this case report in view of vitamin B12 deficiency presenting as diarrhoea.

Vitamin B12 Deficiency in Children Due to Lack of Intake: A Report of Two Cases at the Pediatric Department at Aristide Le Dantec Hospital

We report 2 cases of vitamin B12 deficiency in children due to deficient intake. These were 2 girls aged 4 years (case 1) and 6 years (case 2), respectively, hospitalized in December 2020 and March 2021 in the pediatric ward of Le Dantec hospital. Both patients presented with aregenative anemia, melanoderma and undernutrition. The bone marrow count in case 1 showed a dysmyelopoiesis with megablastosis. The blood vitamin B12 level was low in both cases. Folic acid blood levels were normal in both patients, but an associated martial deficiency was found in case 2. The dietary survey revealed a lack of intake of animal products rich in vitamin B12. Vitamin B12 replacement therapy was effective with rapid regression of all clinical signs observed in both children. The control of the vitamin B12 level after 1 month of treatment was normal in both patients. The disappearance of the symptoms under substitute treatment confirmed the deficiency of Vitamin B12 intake in both patients. Conclusion: Both of our patients had a profound Vitamin B12 deficiency in a context of deficiency in nutrition. The regression of the symptoms was spectacular under vitamin B12 replacement therapy, confirming the deficiency. We recommend in our context a contribution in micronutrients such as vitamins in children after weaning to avoid dietary errors.

Genel Pediatri Polikliniği Vakalarında B12 Vitamini Eksikliği

Objective: This study aims to determine the frequency of vitamin B12 deficiency in children and how it varies according to age groups. Vitamin B12 is an essential vitamin that has an important role in nucleic acid synthesis, erythrocyte maturation, and nervous system development. Vitamin B12 deficiency commonly causes anemia. However, severe deficiency in children can cause permanent neurological damage. Therefore, early detection and treatment of vitamin B12 deficiency make it possible to prevent its permanent effects. In addition, determining the age groups at risk allows early diagnosis. Material and Method: The study included children aged 0-18 years admitted to anambulatory pediatric outpatient clinic. Serum vitamin B12 values of children were examined. Vitamin B12 levels below 200 pg/mL were considered a deficiency and between 200-300 pg/mL a marginal level. Descriptive methods, Chi-square, and Independent Samples T-Test were used in the statistical analysis of the data. Results: The study evaluated data from 3115 children. 49.6% of the participants were girls, and 50.4% were boys. The mean age was 8.2±5.4 years. The mean serum vitamin B12 level was 436 ± 174 pg/mL. This mean was 442±172 pg/mL in girls and 431±177 pg/mL in boys. Mean vitamin B12 levels did not differ by gender. The frequency of serum vitamin B12 deficiency was 4.1%. However, it was significantly higher in boys than in girls (5.2%-3.0%). The frequency of marginal level was 18.4%. The frequency of vitamin B12 deficiency differed according to age groups. Serum vitamin B12 deficiency was seen at the highest rate between 0-6 months, with 11%. This rate was 7.1% in the 6-24-month group. Conclusion: This study showed the frequency of serum vitamin B12 deficiency in children admitted to anambulatory pediatric outpatient clinic and in certain age groups. In addition, it was seen that vitamin B12 deficiency was common, especially in infancy and adolescence. However, multicenter prospective studies are needed to determine the prevalence and causes of deficiency in a wide area.

To Study the Serum Iron and Vitamin B12 Deficiency in Children in Different Communities in the South Indian State of Telangana: A Cross Sectional Study

Background: National Family Health Survey (NFHS-4 2015-2016) documented the prevalence of anaemia as overall more than three-quarters (76 percent) of children. Anaemia is the most common Haematological disease of the paediatric age group. Anaemia is the highest prevalence in developing countries. The population differences in the prevalence of anaemia are explained by environmental factors affecting nutrition, chief among these are economic status, ethnic customs &amp; geographic considerations. Furthermore, there is very limited information on prevalence of Iron and B12 deficiencies among children belonging to different communities with culturally defined eating habits. In the present study carried out to compare the Serum Iron &amp; Vitamin B12 in children of different communities in the South Indian state of Telangana. Material &amp; Methods: In this population based cross sectional observational study was conducted on the department of paediatrics in the Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, Telangana, during the period from 1st January 2020 to till reached the sample size. The study was conducted with the approval from the institutional review and ethical committees. In this study includes children were of the age between 5 to 18 years with the 3 different communities like, Hindu, Muslim &amp; others community. Results: In the above table we shows that the Others community of age is 12.85 ± 2.65 years, Hindu community of age is 12.76 ± 3.46 years &amp; Muslim community of age is 14.96 ± 2.00 years. In our study, the prevalence of Serum Iron was found to be 21.7% (26 out of 120) &amp; prevalence of Vitamin B12 was found to be 50.0% (60 out of 120). Conclusion: The overall prevalence of anaemia (low Haemoglobin) was found to be 43.33%. There was no significant difference between the prevalence of anaemia in 3 different communities. Keywords: Serum Iron, Vitamin B12, Anaemia, Deficiency.

Age dependency of plasma vitamin B12 status markers in Dutch children and adolescents

BackgroundVitamin B12 deficiency in children may be associated with (severe) neurological manifestations, therefore recognition is important. Diagnosing vitamin B12 deficiency in children is challenging. This study aimed to investigate plasma methylmalonic acid, holotranscobalamin, and total cobalamin in children 0–18 years of age and to estimate age-dependent reference intervals.MethodsPlasma vitamin B12 markers were measured in collected plasma samples of 170 children 0–18 years visiting a local primary care laboratory. All had within-reference hemoglobin and MCV values. Pediatric plasma vitamin B12 biomarkers were measured and reference values were derived thereof.ResultsPlasma methylmalonic acid was higher in young children, in particular between 1 and 6 months of age; total cobalamin and holotranscobalamin were highest from 0.5 to 4 years and decreased till 10 years of age. Plasma holotranscobalamin was highly correlated with plasma total cobalamin; their ratio was independent of age. Plasma methylmalonic acid was slightly more related to total cobalamin than to holotranscobalamin. A large proportion of mainly young children would be misclassified when adult references are applied.ConclusionsPediatric reference values for cobalamin markers are necessary to allow for early recognition and monitoring of children suspect of (clinical) cobalamin deficiency.ImpactWe analyzed three plasma vitamin B12 status markers, i.e., total cobalamin, holotranscobalamin, and methylmalonic acid, in the plasma of 170 children 0–18 years of age and were able to derive reference intervals thereof. Recognition of vitamin B12 deficiency in children is important but challenging as pediatric reference intervals for plasma vitamin B12 status markers, particularly plasma holotranscobalamin, are not well described. We think that our results may help early recognition and monitoring of children suspect of (clinical) vitamin B12 deficiency.

Comparison of Sublingual and Intramuscular Administration of Vitamin B12 for the Treatment of Vitamin B12 Deficiency in Children

In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.

Relevance of MCV and Knuckle Pigmentation in Early Diagnosis of Vitamin B12 Deficiency in Children

Background: Vitamin B12 deficiency is common in children, especially who take strict vegetarian diet.Limited data is available on relevance of knuckle pigmentation and elevated MCV for early diagnosis incentral India, especially in pediatric population.Aim: To study association of knuckle pigmentation and elevated MCV with vitamin B 12 deficiency inchildren in central IndiaMethod: This was hospital based cross sectional study, carried out from March 2019 to February 2020.41 children with anemia (Hb &lt; 11 gm%) or knuckle pigmentation or elevated MCV (&gt;100 Fl) or anycombination of these, were enrolled. The association of knuckle pigmentation and elevated MCV withvitamin B 12 deficiency was studied. Data was analyzed by Chi square test. P value &lt; 0.05 was consideredto be statistically significant.Results: 29 out of 41 subjects had vitamin B 12 deficiency, maximum of which were strictly vegetarian.There was statistically significant association between vitamin b12 deficiency with elevated MCV but notwith knuckle pigmentation.Conclusion: Knuckle pigmentation and elevated MCV value may not be seen in every child with vitamin B12 deficiency, but their presence gives important clue to early diagnosis and hence leads to early treatment

Anemia and Iron and Vitamin B12 Deficiencies in Children Under 5 in Mexico: Results from the National Health and Nutrition Survey (ENSANUT)

Abstract Objectives To examine the burden of anemia, iron deficiency, and vitamin B12 deficiency in children under 5 in Mexico. Methods Data from the recently completed National Health and Nutrition Survey (ENSANUT 2018) were analyzed to examine the burden of anemia and micronutrient deficiencies in children under 5 (1 to &amp;lt;5 years). Hemoglobin (Hb) concentrations werequantified in capillary blood samples (n = 3144) via HemoCue.Venous blood samples (n = 1019) were collected, centrifuged, processed, and stored &amp;lt;−80°C until analysis of micronutrient biomarkers. Serum ferritin (SF), C-reactive protein (CRP), and vitamin B12 concentrations were measured via immunoassays. Hemoglobin was adjusted for altitude; anemia was defined as hemoglobin &amp;lt;11.0 g/dL. Iron deficiency was defined as serum ferritin &amp;lt;12.0 µg/L and iron insufficiency was defined as serum ferritin &amp;lt;20.0 µg/L; inflammation was defined as CRP concentrations &amp;gt; 5.0 mg/L (and CRP &amp;gt; 1.0 mg/L). Iron deficiency anemia was defined as hemoglobin &amp;lt;11.0 g/dL and serum ferritin &amp;lt;12.0 μg/L. Vitamin B12 deficiency and vitamin B12 insufficiency were defined as &amp;lt;148.0 and &amp;lt;221.0 pmol/L, respectively. Survey frequency procedures were used to examine the prevalence of anemia and micronutrient deficiencies; survey linear and logistic regression were used to examine associations of micronutrient biomarkers with hemoglobin concentrations and odds of anemia. Results A total of 22.9% of children were anemic in this population. In the biomarker sub-sample, 10.0% of children were iron deficient (SF &amp;lt; 12.0 µg/L), and 29.9% had serum ferritin concentrations &amp;lt;20.0 µg/L. A total of 9.5% of children had CRP concentrations &amp;gt;5.0 mg/L, and 34.7% had CRP &amp;gt; 1.0 mg/L. The prevalence of vitamin B12 deficiency (vitamin B12 &amp;lt; 148.0 pmol/L) was 5.4% and 21.5% of children had vitamin B12 insufficiency (vitamin B12 &amp;lt; 221.0 pmol/L). Conclusions Findings suggest that the burden of anemia and iron and vitamin B12 insufficiency is high in young children in Mexico. Funding Sources ENSANUT was funded by The Ministry of Health of Mexico.

Vitamin B-12 Biomarkers Reviewed: Holotranscobalamin Allows Identification of Vitamin B12 Deficiency in Children with Short-Bowel Syndrome

Abstract Objectives Serum total vitamin B12 (tB12) is the most commonly used biomarker to assess B12 status in healthy and patient populations but there is ambiguity as to its performance for early and reliable B12 deficiency diagnosis. Holotranscobalamin (holoTC) is the B12 form taken up by cells and may be a more sensitive B12 indicator. This descriptive, prospective study aimed to compare serum tB12 with serum holoTC concentration in their ability to detect functional B12 deficiency defined as elevated methylmalonic acid (MMA) concentration in a pediatric population at risk of B12 deficiency. Methods A total of 26 infants and children aged 3 mo-15 yrs with a history of ileal resection were recruited from the Children's Intestinal Rehabilitation Program at the British Columbia Children's Hospital, Canada. Between 1 to 7 samples per patient were collected over 2yrs, with complete biomarker data for 41 samples. Clinical, anthropometric and dietary data were also collected. Age-specific reference limits derived from a healthy pediatric reference sample were used as cut-offs to categorize B12 deficiency. Results Of the 41 samples, 29 (71%) had concordant biomarker results all indicating adequate B12 status. Elevated MMA (&amp;gt;398 nmol/L) was found in only 2 samples and those had holoTC concentration indicative of B12 deficiency (&amp;lt;40 pmol/L) but normal tB12 (&amp;gt;209 pmol/L). While holoTC exceeded tB12 in sensitivity for the detection of functional B12 deficiency, holoTC had reduced specificity, 75% compared to 85% for tB12, leading to a reduced positive predictive value (22%). Patients receiving total parenteral nutrition (TPN) had significantly higher tB12 but similar holoTC concentration compared to those not receiving TPN. Conclusions Overall, the results suggest that serum holoTC detects patients with elevated MMA indicative of B12 deficiency, who are not identified by tB12 concentration, in children with short bowel syndrome. It also suggests that the current cut-off for tB12 may be too low. These descriptive findings warrant further evaluation and validation of B12 biomarkers and related cutoffs for adequate, suboptimal and deficient B12 status. Funding Sources Healthy Starts Catalyst Grant from the British Columbia Children's Hospital Research Institute, Vancouver BC, Canada.

Vitamin B12 deficiency in children from Northern India: Time to reconsider nutritional handicaps.

Background and Aims:Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile.Setting and Design:This prospective analytical study was conducted in a tertiary level care institute in Northern India.Materials and Methods:Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done.Statistics:For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests.Results:A total of 111 children were included. 64.8% (n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair (p 0.056) and knuckle pigmentation (p 0.027). Younger children had more weight loss (p 0.001), knuckle pigmentation (p 0.019) and hypotonia (p 0.045). One fifth of children presented with neurological manifestations.Conclusions:Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [<6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.

Intranasal treatment of vitamin B12 deficiency in children

Vitamin B12 deficiency is traditionally treated with intramuscular injections of cobalamin, which are stressful events for children. In adults, studies have shown adequate absorption of intranasally administered vitamin B12. To date, data concerning efficacy of intranasal administration of vitamin B12 in children are lacking. We report on ten cases of children with vitamin B12 deficiency who were successfully treated with intranasal administration of a spray containing hydroxocobalamin. The mean baseline vitamin B12 concentration increased from 126.3 pmol/l (SD 55.4) to 1914.7 pmol/l (SD 1509.7). No side effects were reported.Conclusion: In children, intranasal application of vitamin B12 seems a safe and effective alternative to intramuscular injections, leading to higher compliance and less burden to patients.What is Known:• Children with vitamin B12deficiency are traditionally treated with intramuscular cobalamin injections, which are costly and painful.• Studies in adults showed that intranasal application of hydroxocobalamin leads to normalisation of vitamin B12levels.What is New:• The intranasal application of vitamin B12resulted in a substantial increase of the mean baseline vitamin B12levels without any side effect.• These data encourage a systematic evaluation of intranasal treatment of vitamin B12deficiency in order to define safety, optimal dosage and administration frequency.

Infantile tremor syndrome: current perspectives.

Infantile Tremor Syndrome (ITS) is a self-limiting clinical state characterized by tremors, anemia, pigmentary skin disease, regression of mental development, and hypotonia of muscles in a plump looking child. Tremors are coarse in character, decreased or disappeared in sleep and resolves within 4–6 weeks in its natural course. Various etiological factors as infectious, metabolic, nutritional have been hypothesized but none is conclusive. Consensus is developing on the role of Vitamin B12 deficiency in children with ITS but is still debatable. Empirical management of ITS children has been tried in the absence of exact etiology considering child as undernourished. Nutritional management includes supplementation of Iron, Calcium, Magnesium, Vitamin B12 and other multivitamins. Tremors can be managed with administration of propranolol most commonly or phenobarbitone, phenytoin, and carbamazepine.

Vitamin B12 Deficiency in Children With Infantile Spasms: A Case-Control Study.

There have been few case reports showing association of vitamin B12 deficiency with infantile spasms. We planned this study to see if there was an association of serum vitamin B12 deficiency in children with development of infantile spasms. Cases included children with infantile spasms of ages 6 months to 3 years. The controls were children in the same age group who had global developmental delay but no history of epileptic spasms. Mean serum vitamin B12, serum homocysteine, and urinary methylmalonic acid levels were measured in both groups and compared. Children with infantile spasms had lower mean serum vitamin B12 levels (354.1 pg/mL; standard deviation 234.1 pg/mL) as compared to children with global developmental delay without spasms (466.7 pg/mL; standard deviation 285.5 pg/mL) ( P value < .05). Mean serum homocysteine level (13.9 vs 7.8 μmol/L, P = .02) and mean urinary methylmalonic acid level (68.1 mmol/mol of creatinine vs 26.1 mmol/mol of creatinine, P = .03) were elevated in children with infantile spasms than in controls. Fourteen children (35.0%) with infantile spasms were vitamin B12 deficient compared with 3 (7.50%) controls ( P = .005). Thus, vitamin B12 deficiency may have an association with infantile spasms. More studies are needed before recommending routine measurement of serum B12 levels in children with infantile spasms.